SCOTLAND has gained an international reputation in terms of its work in changing attitudes to mental ill-health.

Scotland's See Me campaign, challenging the stigma experienced by people with mental health problems, launched in 2002, has resulted in positive shifts in awareness and in attitudes towards mental illness, surveys show. The work goes on, and as the stigma reduces, and more and more high-profile figures, from politicians to actors, discuss their experiences of depression and anxiety, there has been an increase in the number of Scots coming forward for help.

It is essential that when they do, help is available for them. The latest figures on psychiatrist numbers in NHS hospitals, however, suggests that the system is badly stretched by a lack of doctors, with more than two-thirds of training posts empty. So severe is the shortage that none of the eight posts caring for people with learning disabilities was filled, while most higher level training positions were left vacant in old age psychiatry and in child and adolescent psychiatry.

This is a very serious situation and one that clearly requires strategic management. It is on the one hand part of a widespread problem in the NHS in recruiting middle-grade doctors, recently highlighted in The Herald's NHS: Time for Action series of articles: it was revealed two weeks ago, for instance, that most posts for senior trainee emergency doctors in Scotland were left unfilled this summer.

Yet at the same time, psychiatry itself appears to be suffering from the effects of stigma, a tendency, as highlighted by Dr Alastair Cook of the Royal College of Psychiatrists, for medics to look down on the specialism. What a bitter irony. It will seem shocking to patients that there is a shortage of psychiatrists, not because of funding pressures on the NHS, but simply because there aren't enough doctors in the UK who wish to do the job. They will wonder at how the shortfall has been allowed to reach such a serious level.

What seems clear is that demand for the expert skills of psychiatrists is will only increase, not least because of the growing number of people with dementia. There are 86,000 people in Scotland with dementia and with the elderly population due to rise by more than half a million in the next two decades, that figure will rise.

In the Scottish Government's Mental Health Strategy 2012-15, the Minister for Public Health Michael Matheson states: "Key challenges are to continue the good work that has already been started to deliver on our commitments to offer faster access to specialist mental health services for young people and faster access to psychological therapies."

These targets, he continues, "demonstrate how in Scotland we truly give mental health parity with other health services in what we do as well as in what we say".

With so many posts standing empty, patients may doubt that claim.